Glisson, C., Dukes, D., & Green, P. D. (2006). The effects of the ARC organizational intervention on caseworker turnover, climate, and culture in children's service systems. Child Abuse & Neglect, 30(8), 855-880. https://doi.org/10.1016/j.chiabu.2005.12.010

Type of Study: Randomized controlled trial
Number of Participants: 235

Population:

• Age — Not specified
• Race/Ethnicity — 16% Minority
• Gender — 78.8% Female
• Status — Participants were child welfare and juvenile justice workers.

Location/Institution: 25 regions in a southeastern state in the United States

Summary: (To include basic study design, measures, results, and notable limitations)
This study examines the effects of the Availability, Responsiveness, and Continuity (ARC) organizational intervention strategy on caseworker turnover, climate, and culture in a child welfare and juvenile justice system. Case management teams (10 urban and 16 rural) were randomly assigned to either the ARC organizational intervention condition or to a control condition. Measures utilized include the Organizational Climate Survey (OCL) and the Shortform Assessment for Children (SAC). Results indicate that the ARC organizational intervention reduced the probability of caseworker turnover by two-thirds and improved organizational climate by reducing role conflict, role overload, emotional exhaustion, and depersonalization in both urban and rural case management teams. Limitations include significant time commitments and costs associated with the ARC intervention, generalizability of findings to other children's service systems, and study does not assess the impact of the ARC intervention on outcomes for children and families.

Length of controlled postintervention follow-up: 1 year.

Glisson, C., Schoenwald, S. K., Hemmelgarn, A. L., Green, P. D., Dukes, D., Armstrong, K. S., & Chapman, J. E. (2010). Randomized trial of MST and ARC in a two-level evidence-based treatment implementation strategy. Journal of Consulting and Clinical Psychology, 78(4), 537-550. https://doi.org/10.1037/a0019160

Type of Study: Randomized controlled trial
Number of Participants: 615

Population:

• Age — Youth: 9-17 years
• Race/Ethnicity — Youth: 91% Caucasian, 4.6% African American, 2.4% Biracial, 1.0% Hispanic, 0.3% Native American, and 0.3% Other
• Gender — Youth: 69.1% Male and 30.9% Female
• Status — Participants were youth from community mental health programs serving youth that are socially and economically disadvantaged.

Location/Institution: 14 rural Appalachian counties in Tennessee

Summary: (To include basic study design, measures, results, and notable limitations)
A randomized trial assessed the effectiveness of a 2-level strategy for implementing evidence-based mental health treatments for delinquent youth. Participants were randomly assignment 4 treatment conditions (Multisystemic Therapy [MST] plus Availability, Responsiveness, and Continuity [ARC]; MST only; ARC only; control). Measures utilized include the Child Behavior Checklist (CBCL) and the Supervisor Adherence Measure (SAM). Results found that at 6-month treatment outcomes youth total problem behavior in the MST plus ARC condition was at a nonclinical level and significantly lower than in other conditions. Total problem behavior was equivalent and at nonclinical levels in all conditions by the 18-month follow-up, but youth in the MST plus ARC condition entered out-of-home placements at a significantly lower rate (16%) than youth in the control condition (34%). Limitations include reliance on self-reported measures, missing data, and some analyses of MST fidelity and implementation had less power because of the smaller sample size.

Length of controlled postintervention follow-up: 18 months.

Glisson, C., Hemmelgarn, A., Green, P., Dukes, D., Atkinson, S., & Williams, N. (2012). Randomized trial of the ARC organizational intervention with community-based mental health programs and clinicians serving youth. Journal of the American Academy of Child and Adolescent Psychiatry, 51(8), 780-787. https://doi.org/10.1016/j.jaac.2012.05.010

Type of Study: Randomized controlled trial
Number of Participants: 197

Population:

• Age — Mean=33 years
• Race/Ethnicity — 83% Caucasian
• Gender — 68% Female
• Status — Participants were clinicians from community mental health programs serving youth that are socially and economically disadvantaged.

Location/Institution: Southeastern state in the United States

Summary: (To include basic study design, measures, results, and notable limitations)
The study objective was to test whether an organizational intervention labeled Availability, Responsiveness, and Continuity (ARC) could improve the organizational social contexts of community-based mental health programs for youth. The study randomly assigned 26 community-based mental health programs for youth to ARC or control conditions. Measures utilized include the Organizational Social Context (OSC). Results indicate that organizational culture, climate, and work attitudes were significantly improved in the ARC condition after 18 months. Clinicians in programs assigned to ARC reported less rigid, less centralized, and less apathetic organizational cultures; more engaged and functional organizational climates with less role conflict; and work attitudes with improved morale, job satisfaction, and organizational commitment. Limitations include participating clinicians were necessarily aware of whether their programs were assigned to the ARC intervention or control condition and results may not be generalized beyond the participating program due to mostly serving participants from low-income and socially disadvantage youths and lack of follow-up.

Length of controlled postintervention follow-up: None.

Glisson, C., Hemmelgarn, A., Green, P., & Williams, N. (2013). Randomized trial of the Availability, Responsiveness and Continuity (ARC) organizational intervention for improving youth outcomes in community mental health programs. Journal of the American Academy of Child and Adolescent Psychiatry, 52(5), 493-500. https://doi.org/10.1016/j.jaac.2013.02.005

Type of Study: Randomized controlled trial
Number of Participants: 556 (154 clinicians and 402 youth)

Population:

• Age — Children: Mean=12 years, Adults: Mean=32 years
• Race/Ethnicity — Children: 76% Caucasian, 25% African American, and 3% Hispanic; Adults: 83% Caucasian
• Gender — Children: 60% Male, Adults:73% Female
• Status — Participants were community mental health programs that serve youth between the ages of 5 and 18 years.

Location/Institution: Southeastern state in the United States

Summary: (To include basic study design, measures, results, and notable limitations)
The primary objective of the study was to assess whether the Availability, Responsiveness, and Continuity (ARC) organizational intervention improved youth outcomes in community-based mental health programs. The second objective was to assess whether programs with more improved organizational social contexts following the 18-month ARC intervention had better youth outcomes than programs with less improved social contexts. Youth were cluster randomized by program (9 programs randomly assigned to ARC and 9 programs randomly assigned to control) after matching programs on staff size and client population. Measures utilized include the Shortform Assessment for Children (SAC) and the Organizational Social Context (OSC). Results indicate that youth outcomes were significantly better in the programs that completed the 18 month ARC intervention. Analyses also showed that youth outcomes were best in the programs with the most improved organizational social contexts following the 18-month ARC intervention. Limitations include concerns that youth were assigned via cluster randomization by randomly assigning programs to ARC and control, youth do not represent a specific population to which the results can be generalized, and lack of follow-up.

Length of controlled postintervention follow-up: None.

Glisson, C., Williams, N. J., Hemmelgarn, A., Proctor, E., & Green, P. (2016). Aligning organizational priorities with ARC to improve youth mental health service outcomes. Journal of Consulting and Clinical Psychology, 84(8), 713-725. https://doi.org/10.1037/ccp0000107

Type of Study: Randomized controlled trial
Number of Participants: 1080 (475 clinicians and 605 youth)

Population:

• Age — Children: 5-18 years; Adults: Mean=32 years
• Race/Ethnicity — Children: 68.8% White and 25.5% African American, Adults: 82.5% White
• Gender — Children: 54% Male, Adults: 82.1% Female
• Status — Participants were community mental health programs that serve youth between the ages of 5 and 18 years.

Location/Institution: Midwest United States

Summary: (To include basic study design, measures, results, and notable limitations)
This study assessed the effect of the Availability, Responsiveness, and Continuity (ARC) intervention on youth outcomes and the mediating role of organizational priorities as a mechanism linking the ARC intervention to outcomes. Fourteen community-based mental health agencies in a Midwestern metropolis along with clinicians and youth served by those agencies were randomly assigned to the 3-year ARC intervention or control condition. Measures utilized include the ARC Principles Questionnaire (APQ) and the Shortform Assessment for Children (SAC). Results indicate that the rate of improvement in youths' psychosocial functioning in agencies assigned to the ARC condition was 1.6 times the rate of improvement in agencies assigned to the control condition. Limitations include concerns that youth were assigned via cluster randomization by randomly assigning programs to ARC and control, youth do not represent a specific population to which the results can be generalized, and missing data.

Length of controlled postintervention follow-up: 6 and 12 months.

The following studies were not included in rating Availability, Responsiveness, and Continuity (ARC) on the Scientific Rating Scale...

Williams, N. J., Glisson, C., Hemmelgarn, A., & Green, P. (2017). Mechanisms of change in the ARC organizational strategy: increasing mental health clinicians' EBP adoption through improved organizational culture and capacity. Administration and Policy in Mental Health and Mental Health Services Research, 44(2), 269–283. https://doi.org/10.1007/s10488-016-0742-5

This study tests the cross-level change mechanisms that link the implementation of Availability, Responsiveness, and Continuity (ARC) to mental health clinicians' evidence-based program (EBP) adoption and use. Fourteen community-based mental health agencies in a Midwestern metropolis along with clinicians and youth served by those agencies were randomly assigned to the 3-year ARC intervention or control condition. Measures utilized include the ARC Principles Questionnaire (APQ) and the Organizational Social Context (OSC). Results indicate that ARC increased clinicians' EBP adoption and use at 12-month follow-up. These effects were mediated by improvement in organizational proficiency culture leading to increased clinician intentions to adopt EBPs and by reduced job-related EBP barriers. Results also indicated the organizational culture-EBP intentions mechanism was the primary carrier of ARC's effects on clinicians' EBP adoption and use. Limitations include reliance on self-reported measures and generalizability of results due to gender and ethnicity of participants